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Marietta Fire Department - Incident Report Request

  1. Preferred Method of Delivery?*

  2. Requestor Information

  3. Incident Information for Report

    Fire Incident Reports are subject to open records; however, an emergency medical record/report will require the patient, legal guardian, or power of attorney to provide photo identification. When a person other than the patient requests an emergency medical record/report, a notarized HIPAA authorization form or court order is required. Copies of emergency medical records/reports must be picked up in person.

  4. The City will respond to this request within five (5) working days.

  5. Do you agree?*

    By clicking "I agree," you agree and acknowledge that 1) your application will not be "Signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your "electronic signature" is valid and binding upon you to the same force and effect as a handwritten signature.

  6. Leave This Blank:

  7. This field is not part of the form submission.